HomeMy WebLinkAboutMortgage_Wertz •^•no STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count/ Township Year
t FOR DEDUCTION FROM ASSESSED VALUATION
Le 1 ,
State Form 43709(R1216-14) Gi n 0 e sv. 2016
•'• ,,,• Prescribed by Department of Local Government Finance
INSTRUCTIONS: MAR II i
To be filed in person or by mail. orm sled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the grope PI .C• • Auditor
located on or before January 5 of the immediately succeeding calendar year. I1, �In[7.1 i County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor{ji@ • o N a
where the property is located during the twelve(12)months before March 31 of each year the dedd0"c�,o .
- •rOn
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Michael S. Wertz
Taxing District Key number/legal description Re number Pagp qu r
Owensville 26-17-01-404-000.499-022 - (s I f
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
40,200 35,625 a Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
CitiBank, N.A. 0 Real Property ❑ AnnuallAsess61.1-7)
Name of mortgagee or contract seller
1000 Technology Dr. O'Fallon, MO 63368-2240
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city.state.and ZIP code) ded S C'.0 s-oo kj — c ''_ec' /-v '/7?V
4Does applicant own property in any If yes,what county? Mat Taxing District? Has this deduction been requested If yes,state amount of deduction
.other county ,�Cr,,,,✓ on property for
in Indiana? Yes ❑No ay _current year? ❑Yes ❑No
A person is no entitled to this deduction unle ss the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(ow ss full
� e) Date(month,day,year)
Q/_ 3/24/2015
Full re dent address of applica umber and street,city,state.and ZIP code)
5 6 N 1st St., 0 nsville, IN 47665
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day.year)
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.